Reimbursement
Category III CPT Codes
In one line
Temporary CPT codes for emerging technologies, services, and procedures.
Definition
Category III CPT codes (T codes) allow data collection on emerging procedures and devices. They sunset after five years unless converted to Category I, but can be extended.
Category III codes have no national payment value on the Physician Fee Schedule, so payment is set by contractors or private payers case by case, and coverage is often limited. They still help, because a specific code makes claims trackable and builds the utilization data the CPT Panel needs before granting a Category I code. Applications follow the regular CPT Panel cycle.
Why it matters
Category III codes do not guarantee payment but enable claims tracking and serve as evidence for future Category I applications and coverage decisions.
Common pitfalls
- •A common pitfall is misunderstanding that Category III codes do not guarantee reimbursement, leading to financial planning inaccuracies for new MedTech products.
- •Another mistake is neglecting to collect robust data during the Category III period, which can hinder efforts to upgrade to Category I status.
- •Companies often fail to monitor the five-year sunset provision, risking the loss of a code before adequate data for conversion is gathered.